Background: Pre-diabetes is a critical stage in the progression to type 2 diabetes mellitus, making timely intervention essential. Lifestyle changes, including diet modification and physical activity, have shown promise in preventing or delaying diabetes onset. This study evaluates the effectiveness of lifestyle interventions in managing pre-diabetes among rural and urban populations. Materials and Methods: A prospective interventional study was conducted over six months, involving 300 pre-diabetic participants (150 each from rural and urban areas). Participants were enrolled based on fasting blood glucose (100–125 mg/dL) and HbA1c levels (5.7–6.4%). Lifestyle interventions included personalized diet plans, physical activity regimens, and regular health counselling sessions. Blood glucose and HbA1c levels were assessed at baseline, 3 months, and 6 months. Statistical analysis was performed using paired t-tests and ANOVA to compare outcomes between the two groups. Results: At the end of six months, participants in the urban group showed a mean reduction in fasting blood glucose levels from 118.2 ± 4.5 mg/dL to 101.6 ± 3.8 mg/dL, while the rural group showed a reduction from 120.1 ± 5.2 mg/dL to 104.8 ± 4.0 mg/dL. HbA1c levels decreased by 0.9% in urban participants compared to 0.7% in rural participants. Physical activity adherence was significantly higher in the urban group (80%) compared to the rural group (65%). However, dietary compliance was higher in the rural group (75%) compared to the urban group (60%). Both groups demonstrated significant improvements in glycemic parameters, but urban participants exhibited slightly better outcomes. Conclusion: Lifestyle interventions are effective in managing pre-diabetes in both rural and urban populations. Urban participants showed marginally better glycemic control, possibly due to greater adherence to physical activity. Tailored strategies are required to address the specific needs of rural populations to enhance intervention effectiveness.